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From the 7/7/2013 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 27228

Case Details

VAERS ID: 27228 (history)  
Form: Version .0  
Age: 73.0  
Sex: Male  
Location: Unknown  
   Days after vaccination:2
Submitted: 1990-12-22
   Days after onset:23
Entered: 1990-12-28
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC Split Type:

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.

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